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Writing Resources

This guide contains all of the ASC's writing resources. If you do not see a topic, please contact us so we can add the needed topic. .

Clinician Letters

Mental health clinicians are sometimes tasked with writing letters in support of medical interventions for trans clients. Oftentimes, the purpose of these letters is to evaluate the capacity of an individual to consent to medical treatment, including gender-affirming surgery. It is not a clinician's job to prove that a client is trans or nonbinary. They are simply evaluating a person's decision-making capacity. Capacity refers to a person's ability to:

  • Understand - do they understand what the procedure entails?
  • Retain - can they retain that information long enough to consider the options and make a decision?
  • Weigh - do they have the ability to weigh the risks and benefits of the procedure to make a decision?
  • Communicate - can they clearly communicate their decision to others? 

A person's capacity to make a decision must be evaluated in that moment. A clinician's letter provides an evaluation of their client's capacity to make a decision at the time that the evaluation was completed. If too much time has passed between the evaluation and event, a new evaluation may be needed. It is up to the court (or other deciding body) to determine if too much time has passed. Clinicians should be familiar with the requirements of the requesting party before writing a letter.

Note: if it is determined that the client lacks the capacity to make a decision at the time of the evaluation, it is unethical to write a letter in support of the client's capacity.

 

Letter requirements may vary based on who is requesting the documentation. It is often courts or insurance companies, but surgeons and other practitioners could also request an evaluation letter. The guidance provided here is only a starting point. Clinicians should contact the requesting party to ensure their specific requirements are addressed.

Things to Consider:

  • information about the surgical procedure being performed
  • an evaluation of the client's understanding of the procedure
  • the individual's goals/expectations and plans for support following the procedure
  • diagnosis consistent with the surgery (i.e., gender dysphoria)
  • a brief summary of the client's background and general identifying characteristics
  • statement related to potential loss of fertility (for bottom surgery)
  • address possible coercion (or lack of coercion) from external parties

Potential Insurance Requirements:

  • ongoing provider/patient relationship (include the duration of the relationship)
  • history of hormone replacement therapy (or explanation of why they have not had HRT)
  • multiple letters of support for bottom surgery (versus only one for top surgery)

Reference:

Phillips, A. (2025, January 4). What's in a letter? Spectrum Reproductive Health & Gender Affirming Care. 

https://www.spectrumreproductivehealth.com/blog/whats-in-a-letter

Best Practices for Writing Affirming Letters

  • What Makes a Good Letter?
    • Clarity, conciseness, and inclusion of relevant details.
    • Use of affirming language that respects the client’s gender identity.
    • Avoid including unnecessary or overly personal details about your client’s history
  • Core Components:
    • Client’s name and pronouns.
    • Diagnosis and history (if applicable).
    • Clinical reasoning for recommending the intervention.
  • Dos and Don’ts:
    • DO use the client’s affirmed name and pronouns consistently.
    • DON’T include unnecessary or stigmatizing information.
  • Jurisdiction-Specific Requirements:
    • Be aware of any specific requirements for letters in your region
  • Resources:

Sample Template

  • The headings in this template identify the specific areas of the sample letter. 

[Your Practice/Clinic Name]
[Address]
[City, State, ZIP Code]
[Phone Number]
[Email Address]

[Date]

To Whom It May Concern,

I am writing to provide a letter of support for my client, [Client’s Full Name], who identifies as [Client’s Gender Identity] and uses [Client’s Pronouns]. I have had the privilege of working with [Client’s First Name] in my role as [Your Role/Title] since [Date You Began Working Together]. During this time, I have evaluated and supported [Client’s First Name] in their journey toward gender affirmation.

Diagnosis and Medical Necessity

[Client’s First Name] meets the diagnostic criteria for [Gender Dysphoria (ICD-10: F64.0, DSM-5: 302.85), or other relevant diagnosis]. This condition is associated with significant distress and impairment in [Client’s First Name]’s daily life. Based on the Standards of Care outlined by the World Professional Association for Transgender Health (WPATH), gender-affirming [surgery, hormone therapy, or other intervention] is a medically necessary step to alleviate this distress and support [Client’s First Name]’s health and well-being.

Clinical Evaluation

I have assessed [Client’s First Name] thoroughly, and it is my professional opinion that they are an appropriate candidate for [specific medical intervention]. They have demonstrated:

  • Persistent, well-documented gender dysphoria.
  • Capacity to make informed decisions about their care and provide consent for treatment.
  • [If relevant:] A history of adherence to treatment plans or a stable social and mental health condition.

 

Recommendation

It is my professional recommendation that [Client’s Full Name] be approved for [specific intervention, e.g., “gender-affirming chest surgery” or “hormone therapy”]. This intervention is essential to support [Client’s First Name]’s physical and mental health, enabling them to live authentically and thrive.

Closing Statement

Please do not hesitate to contact me at [Your Phone Number] or [Your Email Address] if further information is needed to support this request. Thank you for your attention and support in providing care for [Client’s First Name].

Sincerely,
[Your Full Name], [Your Credentials]
[Your Job Title]
[Your Organization or Practice Name]

Template Reference:

Academic Success Center. (2025). Letter of support template for clinicians: Gender-affirming care. Content created with assistance from ChatGPT. 

Additional Letter Examples

References for Addition Letter Example Links:

American Psychiatric Association. (2017). Writing letters of support to insurers and surgeons. 

https://www.psychiatry.org/psychiatrists/diversity/education/transgender-and-gender-nonconforming-patients/letter-writing

Mosser, S. (n.d.) Writing a letter of support for gender affirming surgeries. The Gender Confirmation Center. 

https://www.genderconfirmation.com/wp-content/uploads/2024/01/How-to-Write-a-Letter-of-Support-Adult-2-1.pdf